The goals of this application are to: 1) determine what level of involvement by the primary care practitioner (PCP) is required to inform and encourage adults age 65-75 to follow through with routine hearing screening; 2) develop a model of effective adult hearing screening, based on resource utilization and screening compliance in each intervention group, that maximizes identification of hearing loss in affected patients and minimizes burden to the PCP and patient; 3) determine what factors are important to adults 65-75 in making decisions about hearing screening and interventions and develop strategies to optimize appropriate intervention; and 4) provide data on the ability of patients, audiologists and primary care providers to identify significant medical conditions that should be evaluated by an ear specialist prior to hearing aid procurement. This latter goal could help to inform FDA policy which currently requires either medical evaluation and clearance or a waiver to forego medical evaluation prior to hearing aid fitting. The current recommendation by the FDA is not evidence-based, and has been interpreted by some as prohibitive of less resource-intensive care delivery models such as remote hearing aid sales or over the counter (OTC) procurement. In the proposed research, we will compare implementation of three PCP-based hearing screening strategies (total N=660) that include progressive levels of PCP time and guidance to complete telephone-based hearing screening. Those who fail screening (estimate: N=100) go on to a medical referral study and receive (1) diagnostic audiological testing and (2) determination of the reliability and validity of identification of conditions that should require medical referral pior to hearing aid provision. The N in the medical referral study from the PCP-based screening is complemented by a sample of 500 patients from the NIH-funded CHEER network seen for ear related problems. A successful implementation of the study will help us understand: 1) the most effective and cost-efficient strategy for hearing screening implementation in this population; 2) the factors that are important to patients in their decisions regarding hearing healthcare; 3) the level of medical care required to insure that hearing aid fitting is safe, and whether the 'medical model' of hearing aid procurement is warranted. Our team of collaborators includes providers and academics of diverse backgrounds, to provide wide expertise and perspective. The study will utilize both PCP practices from the Primary Care Research Consortium in the Duke Health System, and the NIH-supported CHEER practice-based network, to ensure diversity of patient enrollment and generalizability to community practice. Our research will serve as the basis for future efforts to meaningfully influence health care approaches to hearing loss and health care policy related to hearing health care delivery, including FDA policy on hearing aid care delivery. Our ultimate goal is to provide information to inform changes in health care policy to facilitate accessible and affordable hearing health care.